Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 06990 | Date 26/11/2019 |
| Token No | SM/19-20/14024 26/11/2019 | Serial | 031 Last Visit: 20/12/2019 |
| Patient Name | Mr. UMA SHANKAR RAY | Contact No | 8274025435 |
| Address | SANPUKUR DHAR GOLABBAG NICHU MATH, BAIDYABATI(M) | Age | 58 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 49 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||